Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | MA50922 | NJ |
NPI | 1215902325 |
---|---|
Provider Name | John A Infantolino |
First Address | Brick, NJ 08724-3515 |
Second Address | Brick, NJ 08724-3515 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2006 |
Last Update Date | 02/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1746804 | (05) | NJ |
C55553 | (02) | NJ |